Understanding Depression: Why Knowing the Cause Isn’t Always Enough to Change It

What Understanding Depression Typically Accomplishes

Understanding depression is often clinically useful. When understanding, we learn what activates it, how our childhood experiences or recent trauma contributed to it or if it is the cause, and how it influences our perception and behavior. Essentially, we know where it comes from and what it is connected to. We may know what it feels like and be able to describe it. Even if we don't know where it stems from, we know the context we experience it in. Knowing why often provides clarity.

Having an understanding of depression allows us to develop the language to articulate the thoughts and emotions, its origins, and how it shaped perception and influenced behavior. From an Acceptance and Commitment Therapy perspective, this is part of the acceptance process where we describe and label associated negative emotions, thoughts, and memories. As this happens, we automatically make space for them and allow them to exist without changing them or judgment. The space created then alleviates the intensity of the depression because we are able to let go as opposed to being fused, or hooked, onto them.

We may find that at the core of depression sits the belief of worthlessness. Sometimes knowing why we feel worthless is enough to change it because when we say it out loud and actually hear the belief, that can reveal how disconnected the belief is from our lived experience. When this realization happens, we start to treat the belief as a distortion, which then dispels the hold it has on us, or at least it begins to. As a result, a sense of relief, or emotional catharsis, is created. However, this is an exception. It is not always the case that knowing why we feel worthless can change the feeling. This is especially the case when our environment does not change.

Why Understanding Isn't Always Enough

As we can see, articulation can often create emotional catharsis, which in itself is therapeutic. In many cases, however, understanding alone is not enough to reduce or eliminate depression symptoms long after treatment is completed. This is because understanding does not completely treat the underlying core. The core of depression is usually centered around worthlessness and hopelessness. Understanding it can unveil this part, but it does not change the psychological and behavioral mechanisms that reinforce it.

For example, when a person suffers from depression, it may have existed for so long that they believe that there's no hope in changing it; it's who they are. To this person, it is better to deal with the devil they know than the devil they don't know. As a result, depression functions as stability and comfort, which ironically supports the belief that there is no hope in changing it. Since there is no hope, from their perspective, they have little or no incentive to address the depression. Instead, they may engage in self-destructive behaviors that, in the short term, alleviate symptoms, but this actually just suppresses them and encourages avoidance, which ultimately serves to prolong the depression.

The above example demonstrates a function of depression. This person may very well understand that the depression serves them exactly as I explained. But seeing the function does not change the function. If you notice, this person continues to engage in behaviors that support depression. The thoughts and actions of this person have not been interrupted, so the depression continues.

So then, what actually changes depression?

What Is Enough?: The Other Part Of Treatment

Research indicates that taking meaningful action instead alleviates depression long term, leading to sustained outcomes that last far beyond the end of treatment. Meaningful actions are deliberate and pointed actions specifically designed to target the core of depression. Meaningful actions are behaviors that are connected to, support, and reinforce re-engagement in our values. As such, these actions end up being specially tailored to address the psychological core and behavioral manifestations of depression.

Depression is often shaped by schemas (and can also shape schemas), mental frameworks that create belief systems, which then influence how we think, reason, and behave, reinforcing depression and continuing a vicious cycle (see Mental health implications). The research shows that taking meaningful action interrupts this cycle, leading to improved self-esteem, confidence, a sense of accomplishment, motivation, and the ability to experience joy and satisfaction. In turn, new schemas are formed, which reinforce thoughts and behaviors that support mood-boosting, meaningful actions.

Looking at the same example to see how applying meaningful action can alleviate depression, since this person has treatment-resistant depression, they already believe that nothing works and there's no point in trying. The idea of giving a host of things to do haphazardly will just turn them away, especially if they're not aligned with their core values. They'll see it as overwhelming and a waste of time. So, in this context, a meaningful action would be taking a single step. However, not just any step. The single step has to be something that meets specific criteria: it's a simple/straightforward task, relatively convenient, in an environment that encourages interaction, and it's interesting.

Taking one step has a larger philosophical point. It highlights how one step can ultimately be the beginning of a cascade of events that lead to more enriching experiences, which provide a plethora of evidence that tends to dispute and disrupt the psychological and behavioral mechanisms that support depression. Simply put, taking one step can have a domino effect that creates positive experiences that are rewarding, which encourages repetition of said behavior. If we use the prior example again, should this person take one step, they would be opening themselves up to the possibility of seeing that there is a life without depression, thus building hope and motivation. I have a detailed explanation of how action creates experiences that reshape how we think, perceive, and act, improve mood and self-esteem, and different types of actions that can be taken here (section: How to stop negative self-talk and improve self-esteem).

Final Thoughts

It can be reasonably argued: how can taking one step be effective with someone who believes there's no point? The reason is quite simple: the stakes are low. This person does not have to make a considerable emotional investment because there is only one thing required of them: just show up. Their experience will take care of the rest.